Beta agonist : reverse ASM contraction ->

Management of asthma:

Goals of management

1. Reduced impairment of function cause by asthma
2. Reduce incidence of adverse outcomes due to asthma - (i.e exacerbations, hospitalization)
3. Reduce side effects from the medication

Arms of management

Many simultaneous actions are taken to achieve the goals mentioned above.
One of which is medication.
Pharmacologic treatment is the mainstay of management in most patients with asthma.

Quick relief medication

Two options:

1. Fast acting beta agonist - Salbutamol OR formoterol
2. For patients with persistent asthma - low dose glucocorticoid with fast acting beta agonist. (budesonide + salbutamol) OR (budesonide + formoterol)

Controller medication

[!INFO] Initiation level Vs. adjustment
✳️ Level of initiation of controller medication -> determined by asthma severity. See below:
[[AsthmaControllerTherapy.png]] <- two parallel guidlines : GINA and NAEPP

✳️ Adjustment of asthma therapy is done according to assessment of asthma control.
[[AsthmaControlAssessment.png]] <- based on GINA

Asthma control has two domains: (see section A and B in the table)

1. symptom control and
2. risk of future exacerbations

Assess the symptom control domain by patient's recall of previous 4 weeks; assess risk of future exacerbations by the presence of risk factors and by spirometry/or peak flow measures.

Level of initiation is determined at first assessment.
Then treatment level is adjusted to achieve best control with minimum side effects.